By Russ Herring, DNP, FNP-BC, CSCS
I am fortunate to be a healthcare provider in the first world. I am fortunate that I have computers, labs, specialists and access to medicines unavailable to much of the world. I know that I am lucky to practice where I do, and when I do. The reality is that healthcare providers in the United States are at least as fortunate as those we care for. I am, admittedly, a newer provider, and I arrive at a point in modern history, in a first-world country, when I have yet to encounter a disease, condition or situation for which there are no treatments.
Hepatitis? We have a constellation of antiviral medications.
HIV? I grew up in the age of HIV/AIDS. I still remember Ryan White dying from AIDS after a blood transfusion in the 80s. His death was probably the first time I’d heard of HIV or hemophilia. HIV is now considered a survivable disease if you have access to the appropriate medications.
If you have access to the appropriate medications.
I have patients on HIV medications who have survived for decades. I have others on pre-exposure prophylaxis. We haven’t conquered HIV/AIDS, but we have learned how to deal with it.
We treat cancers with surgeries, radiation, chemotherapy.
I can honestly say that, until very recently, I’d yet to be visited by the patient beset with a condition for which I had zero answers. Within primary and immediate care practice, we prescribe antibiotics, steroids, inhalers, creams, blood pressure medications, blood thinners and on, and on, and on – every day. We refer blood disorders and cancers to our good friends, Dr. Tom Warr and Dr. Karl Guter. They’re always a phone call away when we need help. Dr. Ray Geyer and his staff are at the other end of the phone, or email, whenever we have a question about infectious disease. Dr. Geyer is generally a very quiet, reserved man, but he’s had to become more comfortable being the center of attention this year. If we need to talk about hearts, Dr. Jorge Castriz, Dr. Mike Ritchie or Ellen Sparks, PA (extraordinaire) are always happy to help.
As I catch up on my weekly charting every Sunday afternoon, I review charts and lab tests from my laptop at home. I write prescriptions and referrals to a fleet of specialists for half the day – from the comfort of my living room, over wifi, while drinking a gallon of coffee and listening to music.
It is comfortable. I have it easy. If I have questions, I can find answers.
Then came SARS-CoV-2 and COVID-19.
In clinical practice we report lab results to dozens of patients every day, with the nurses reporting normal findings. There are just too many labs, too many tests, and too many patients. The providers are in exam rooms with patients all day, every day, and have to ask our staff for help with this task. Generally speaking, if you hear the provider’s voice, we need to have a more involved conversation. If there needs to be a discussion more complicated than, “your labs were normal and Russ would like to repeat them in…” then you’ll probably hear my voice on the other end of the phone.
I can call patients from work. Or from home, with my cellular phone. There is never a gap in connectivity.
Negative COVID tests are reported by the staff. “Your test for COVID-19 was negative and you may remove yourself from self-quarantine.”
If you hear my voice calling with a COVID-19 test result, you’re about to hear me reporting a positive result.
“What do I do if the shortness of breath gets worse?”
I feel as though I’ve been punched in the gut. What does he do if the shortness of breath gets worse? I don’t have a magic drug. I don’t have a medical subspecialist who can give me the answers over the phone because they’ve treated this a thousand times before.
I’m reporting a positive result to an elderly gentleman who’d likely caught the infection from a younger family member.
This is when I make COVID-19 about me. I sleep better when I go to bed knowing that I helped the patients who’d come to me for help. I sleep soundly when I know that these patients are better for having met, and been treated by, me.
This is not possible with COVID-19. There are NO definitive treatments. I can’t tell you, with certainty, whether you’ll be fine, get a little sick, or die swiftly should you become infected.
We keep getting surprised by who does, and who does not, survive relatively unscathed, or falls mortally ill from COVID-19.
I’ve had patients ask me about hydroxychloroquine, a medication used as an anti-malarial, to treat lupus and rheumatoid arthritis, which can have extremely dangerous, even life-threatening side effects. I’ve had patients with extensive histories of cardiovascular disease ask about hydroxychloroquine. Montanans are pragmatic. I’ve had patients ask about Ivermectin, with plans to hijack the supply from their livestock for personal use.
“Some people say that Ivermectin helps. Some people say that hydroxychloroquine is safe and effective for COVID.”
Some people do say these things, but double blind, randomized clinical trials do not. Real science does not support hydroxychloroquine or azithromycin for the treatment of COVID-19. In fact, Kim and Gandhi (2020) note that, in a randomized clinical trial, 1,561 hospitalized patients treated with hydroxychloroquine had neither lower mortality rates, nor shorter hospital stays than 3,155 patients not treated with hydroxychloroquine. A retrospective analysis of patients hospitalized in New York, found higher rates of death and intubation in the 811/1,400 patients who had been treated with hydroxychloroquine (Kim & Gandhi, 2020). Both the WHO and NIH terminated the hydroxychloroquine arms of their clinical trials after they were found, clearly, to lack improved clinical outcomes (Kim & Gandhi, 2020).
Recently, a video was rapidly circulated across the internet, in which a physician from Texas claimed to have had no deaths within their practice, while using a combination of hydroxychloroquine and azithromycin. This video was rapidly removed from the mainstream internet, as the claims made were… Likely utterly fallacious and unsupported. The ad hominem attacks against the physician were difficult to avoid, as they turned out to also be fond of making bizarre claims about the supernatural. The video wasn’t sent to the depths because the physician was spreading some secret treatment the Illuminati didn’t want you to hear about, it was cast from the internet because it was dangerous, negligent, and wrong.
Besides being repetitiously shown to have no positive impact on COVID-19 outcomes, hydroxychloroquine and azithromycin can both impact heart rhythms – dangerously. There are, certainly, treatments utilized within healthcare which are thinly supported by scientific evidence. Antibiotics for pink eye or the common cold, happen daily. It isn’t right, but the downside, the danger, isn’t as immediate as causing cardiac arrest with dangerous drugs in a patient who is already ill with a potentially fatal infection.
“What do I do if my shortness of breath gets worse?”
Do not catch COVID-19 in the first place. Until we have treatments. Until I can look you in the eye and say, “I’ve got just the thing”.
Take it seriously. It is serious. We can’t even, definitively, predict how you’ll fair if you catch COVID. Young, old, thin, fat – people of every stripe have lived, while seemingly identical others have perished.
America hasn’t embraced preventative healthcare like we should, but the only treatment for COVID-19, currently, the only guaranteed treatment is to prevent catching it in the first place. I’m a primary care provider. I’m a nurse. I prefer preventing disease to treating disease. I’d rather you lose weight and eat more broccoli, than come in with diabetes and high blood pressure. I have just the medications for those conditions, but I’d honestly rather not have to use them. I’d rather treat you with salad and fresh air. Every day of the week and twice on Saturday.
Recently, I was in the checkout line at a big-box store. I was wearing a mask, as was my wife – as was everyone, except for one couple in the isle beside us. The unmasked gentleman (he was very polite, and this was in no way one of those unhinged videos we’ve all seen by now on the Internet) asked the young man checking out in front of him whether he was wearing a mask for his (the wearer’s) safety, or for the safety of other people. Both of these men were thin, and likely under 30 years of age. I wasn’t able to hear the young man’s response.
I have a big mouth. It gets me in trouble. Some love this quality about me, others hate it.
I wanted to jump into their conversation. I wanted to tell the man that he probably wasn’t actually wearing the mask for either of their safety, individually. Both were younger, and thin. Statistically, both parties were likely to be fine, though as mentioned earlier, we can’t really say that unequivocally. The odds were in their favor. The mask was for their parents, for their grandparents. The mask was to keep COVID from spreading into another nursing home or college dorm. The mask was to keep people they didn’t even know safe.
Recently, a wedding reception in Maine broke the state’s indoor gathering restrictions. Contact tracing from the event is now up to 147 positive COVID-19 cases, with nursing homes and jails involved across multiple states (Lewis, 2020). Three people have died. People unassociated with the event have passed away, having caught COVID-19 from wedding guests (Lewis, 2020). We’ve seen, over and over again, how nursing homes, in particular, have faired exceptionally poorly when confronted by COVID-19. How would you feel if you remember your wedding day as that time in 2020 when your wedding resulted in dozens of deaths?
I can’t imagine.
Protect yourself, please. Protect your loved ones. Protect me from having to tell you that I can’t help you.
About Russell Herring, DNP, FNP-BC, CSCS
Russell R. Herring, DNP, joined the Great Falls Clinic in 2018 and is among the newer healthcare providers in the State of Montana. He works alongside Drs. David Engbrecht and Dr. Carey Welsh in Family Medicine at the Great Falls Clinic Northwest location. Russell specializes in diagnostic, preventive, and therapeutic healthcare and treatment plans for acute and chronic illness, and in education and guidance of patients regarding disease prevention and health promotion. He is currently accepting new patients at the Northwest Clinic, 1600 Division Road, Great Falls. For more information or to schedule an appointment, please call 406-268-1600.
Kim, A.Y., Gandhi, R.T. Coronavirus disease 2019 (COVID-19): Management in hospitalized adults. Uptodate. Accessed August 9, 2020 from: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-hospitalized-adults?search=covid%2019%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1146559893
Lewis, S. 147 COVID-19 deaths and 3 deaths now linked to indoor wedding reception in Maine. Retrieved September 5, 2020 from: https://www.cbsnews.com/news/covid-19-3-deaths-indoor-wedding-reception-millinocket-maine-disease-outbreak/